APPLICA
ATION FOR TU
UITION FEE W
WAIVER
R
MANA
AGEMEN
NT and OPEIU
U cover ed emp
ployees
s
( Taking
T
Course
es Under the Non-Instructio
onal Tuition W
Waiver Policy)
SECT
TION I – Ques
stions shoulld be directed to Human Resources. (PLEASE PR
RINT)
EMPLO
OYEE NAME:
EMPL
LOYEE ID:
Seme
ester: (Plea
ase check one)
o
Fa
all 20____
Spring 20_
____
Summer I 20___
__
Barga
aining Unit: (Please check one)
Summ
mer II 20____
_
MANAGEM
MENT
Other_
___________
____________
_
OPEIU (Nu
urses)
Note: Employees of OPEIU units must have
e completed th
heir probation
nary period prrior to beginning of attending semester to
be eligible fo
or tuition waiv
vers.
INDEPENDENT STUDY / INDIVIDUA
ALIZED INSTRUCTION (IS
S/II) COURSE
ES ARE NOT
T COVERED BY TUITION
WAIVER. IT IS THE EM
MPLOYEE RE
ESPONSIBILITY TO IMME
EDIATELY R
REPORT ANY
Y IS/II COURS
SES ADDED
AFTER TUIITION WAIVE
ER FORM HA
AS BEEN SUB
BMITTED TO
O HUMAN RE
ESOURCES F
FOR THAT S
SEMESTER.
The fo
ollowing underg
graduate cours
se(s) I am req
questing for pe
ermission to ta ke at Kutztown University iss/are under the
e tuition waiver
provisions of my barg
gaining unit contract. I underrstand that this request is for ttuition only, an
nd that I am ressponsible for all aspects of the
e
er semester (Fall, Spring & S ummer I or II) m
may be taken.
registrration process. A maximum of 6 credits pe
COURS
SE NUMBER AND TITLE:
CREDITS
S:
DAYS AND T
TIME OF CLASS:
COURS
SE NUMBER AND TITLE:
CREDITS
S:
DAYS AND T
TIME OF CLASS:
COURS
SE NUMBER AND TITLE:
CREDITS
S:
DAYS AND T
TIME OF CLASS:
I understand that I must
m
make up any
a missed tim
me from my reg
gular work sch
hedule and I am providing an
n alternate work schedule for
g up time for atttending class(e
es). I also und
derstand that th
his information is required to ccomply with contractual requirements.
making
I plan to make up fo
or work time missed in taking
g classes by the following alte
ernative sched
dule. (Your pla
an for making u
up lost time for
attend
ding class may NOT exceed 8 hours of work
k time each day
y.) Please incllude 10 minute
es to go and 10
0 minutes return
n from class.
Totall time neede
ed to attend
d classes pe
er week:
ALTE
ERNATE SCH
HEDULE
Monday
________
__________
________ (in hours/min
nutes)
Tues
sday
Wednesday
Thurs
sday
Friday
Startin
ng Time:
Lunch
h Time:
Ending Time:
Total W
Work Hours Per Day:
Comm
ments:
Pleas
se explain ho
ow this cours
se(s) directly
y related to your
y
position
n and provide
es job-relate
ed training:
Emplo
oyee Signaturre
Date
Note: This application should be su
ubmitted no late
er than eight weeks prior to th
he deadline forr payment each
h semester.
proving this waiver, I have re
eviewed this request and I un
nderstand that tthe resulting a
absence must n
not cause any additional cos
st
By app
to the university. I have
h
reviewed the plan to ma
ake up any work missed. I u
understand thatt the operation
nal needs of m
my function take
e
preced
dence, and that I may refuse this
t
request if it would disrup
pt the work sche
edule or resultt in additional c
cost.
Superrvisor Signatu
ure
●Bursar’s Office
●Human Resources
Date
Name:
Line 1:
Semester:
Line 2:
Line 3:
SECTION II – (To be completed by Human Resources)
MANAGMENT
Full-time employee with more than 9-Month position
OPEIU (Nurses)
Full-time employee with completed probationary period
Checklist:
1. Job-related explanation completed
2. On active payroll of university
3. Satisfactory performance evaluations
4. Positive leave balance
5. Approval from manager
6. Written plan to make up work missed
7. No additional personnel costs for taking courses(s)
NO INDEPENDENT STUDY/INDIVIDUALIZED INSTRUCTION COURSES
8. Certification signature of reviewing staff member
9. Waiver approval signature
A C C O U N T I N G
PS TUITION:
C ODES
PS TECH FEE:
Verified by: Initials___________ Date___________ Entered___________
Approval:
Executive Director of Human Resources
●Bursar’s Office
●Human Resources
Date